2009 EM Model - Website Document W-History

2009 Model of the Clinical Practice of Emergency Medicine
Jointly approved by ABEM, ACEP, CORD, EMRA, RRC-EM and SAEM August 2009
Jointly approved by ABEM, ACEP, CORD, EMRA, RRC-EM, and SAEM and approved by the
ACEP Board of Directors August 2007.
Approved by the ACEP Board of Directors September 2003
Approved October 2000 and September 2005 replacing Model of the Clinical Practice of Emergency
Medicine.
Originally approved titled, Core Content for Emergency Medicine December 1996.
The Core Content Task Force II created and endorsed the 2001 Model of the Clinical Practice of
Emergency Medicine (EM Model) as published in the June 2001 Annals of Emergency Medicine
and Academic Emergency Medicine.
The 2003 EM Model Review Task Force reviewed the 2001 EM Model, as requested by the
Core Content Task Force II. Their work was published in the June 2005 Annals of Emergency
Medicine and the June 2005 Academic Emergency Medicine.
The 2005 EM Model Review Task Force conducted the second review of the EM Model. Their
work is published in the October 2006 issue of Academic Emergency Medicine and online-only
in Annals of Emergency Medicine.
The 2007 EM Model Review Task Force conducted the third review of the EM Model. Their
work is published in the August 2008 issue of Academic Emergency Medicine and online-only in
Annals of Emergency Medicine.
The 2009 EM Model Review Task Force conducted the fourth review of the EM Model.
2009 EM Model Review 2007 EM Model Review 2005 EM Model Review

Task Force Task Force Task Force
Debra G. Perina, M.D., Chair Harold A. Thomas, M.D., Chair Harold A. Thomas, M.D., Chair
Michael S. Beeson, M.D Michael S. Beeson, M.D Louis S. Binder, M.D.
Douglas M. Char, M.D. Louis S. Binder, M.D. Dane M. Chapman, M.D., Ph.D.
Francis L. Counselman, M.D. Patrick H. Brunett, M.D. David A. Kramer, M.D.
Samuel Keim, M.D., MS Merle A. Carter, M.D. Joseph LaMantia, M.D.
Douglas L. McGee, D.O. Carey D. Chisholm, M.D. Debra G. Perina, M.D.
Carlo Rosen, M.D. Douglas L. McGee, D.O. Philip H. Shayne, M.D.
Peter Sokolove, M.D. Debra G. Perina, M.D. David P. Sklar, M.D.
Steve Tantama, M.D. Michael J. Tocci, M.D. Camie J. Sorensen, M.D., M.P.H.
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2003 EM Model Review Core Content Advisory Panel to the

Task Force Task Force II Task Force
Robert S. Hockberger, M.D., Chair Robert S. Hockberger, M.D., Chair William J. Koenig, M.D., Chair
Louis S. Binder, M.D. Louis S. Binder, M.D. James J. Augustine, M.D.
Carey D. Chisholm, M.D. Mylissa A. Graber, M.D. William P. Burdick, M.D.
Jeremy T. Cushman, M.D. Gwendolyn L. Hoffman, M.D. Wilma V. Henderson, M.D.
Stephen R. Hayden, M.D. Debra G. Perina, M.D. Linda L. Lawrence, M.D.
David P. Sklar, M.D. Sandra M. Schneider, M.D. David B. Levy, D.O.
Susan A. Stern, M.D. David P. Sklar, M.D. Jane McCall, M.D.
Robert W. Strauss, M.D. Robert W. Strauss, M.D. Michael A. Parnell, M.D.
Harold A. Thomas, M.D. Diana R. Viravec, M.D. Kent T. Shoji, M.D.
Diana R. Viravec, M.D.
All changes that resulted from the 2009 EM Model Review Task Force are summarized in
Figure 1.
Preamble of the Core Content Task Force II, Adapted for the 2009 EM Model
In 1975, the American College of Emergency Physicians and the University Association for
Emergency Medicine (now the Society for Academic Emergency Medicine; SAEM) conducted a
practice analysis of the emerging field of Emergency Medicine. This work resulted in the
development of the Core Content of Emergency Medicine, a listing of common conditions,
symptoms, and diseases seen and evaluated in emergency departments. The Core Content
listing was subsequently revised four times, expanding from 5 to 20 pages. However, none of
these revisions had the benefit of empirical analysis of the developing specialty but relied solely
upon expert opinion.
Following the 1997 revision of the Core Content listing, the contributing organizations felt that
the list had become complex and unwieldy, and subsequently agreed to address this issue by
commissioning a task force to re-evaluate the Core Content listing and the process for revising
the list. As part of its final set of recommendations, the Core Content Task Force recommended
that the specialty undertake a practice analysis of the clinical practice of Emergency Medicine.
Results of a practice analysis would provide an empirical foundation for content experts to
develop a core document that would represent the needs of the specialty.
Following the completion of its mission, the Core Content Task Force recommended
commissioning another task force that would be charged with the oversight of a practice
analysis of the specialty - Core Content Task Force II.
The practice analysis relied upon both empirical data and the advice of several expert panels
and resulted in The Model of the Clinical Practice of Emergency Medicine (EM Model). The EM
Model resulted from the need for a more integrated and representative presentation of the Core
Content of Emergency Medicine. It was created through the collaboration of six organizations:
• American Board of Emergency Medicine (ABEM)

• American College of Emergency Physicians (ACEP)
• Council of Emergency Medicine Residency Directors (CORD)
• Emergency Medicine Residents’ Association (EMRA)
• Residency Review Committee for Emergency Medicine (RRC-EM)
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• Society for Academic Emergency Medicine (SAEM)
As requested by Core Content Task Force II, the six collaborating organizations reviewed the
2001 EM Model in 2002-2003 and developed a small list of proposed changes to the document.
The changes were reviewed and considered by 10 representatives from the organizations, i.e.,
the 2003 EM Model Review Task Force. The Task Force’s recommendations were approved by
the collaborating organizations and were incorporated into the EM Model. The work of the Task
Force was published in the June 2005 Annals of Emergency Medicine and Academic
Emergency Medicine.
The six collaborating organizations reviewed the 2002-2003 EM Model in 2005 and developed a
small list of proposed changes to the document. The changes were reviewed and considered
by nine representatives from the organizations, i.e., the 2005 EM Model Review Task Force.
The Task Force’s recommendations were approved by the collaborating organizations and were
incorporated into the EM Model. The work of the Task Force was published in the October
2006 Academic Emergency Medicine and December 2006 Annals of Emergency Medicine.
The next regular review of the EM Model occurred in 2007. The 2007 EM Model Review Task
Force recommendations were approved by the collaborating organizations and are incorporated
into this document. The work of the Task Force was published in the August 2008 Academic
Emergency Medicine and online-only in the August 2008 Annals of Emergency Medicine.
The fourth review of the EM Model occurred in 2009. The 2009 EM Model Review Task Force
recommendations approved by the collaborating organizations are incorporated into this
document.
There are three components to the EM Model: 1) an assessment of patient acuity; 2) a

description of the tasks that must be performed to provide appropriate emergency medical care;
and 3) a listing of common conditions, symptoms, and disease presentations. Together these
three components describe the clinical practice of Emergency Medicine and differentiate it from
the clinical practice of other specialties. The EM Model represents essential information and
skills necessary for the clinical practice of Emergency Medicine by board certified emergency
physicians.
Patients often present to the emergency department with signs and symptoms rather than a
known disease or disorder. Therefore, an emergency physician’s approach to patient care
begins with the recognition of patterns in the patient’s presentation that point to a specific
diagnosis or diagnoses. Pattern recognition is both the hallmark and cornerstone of the clinical
practice of Emergency Medicine, guiding the diagnostic tests and therapeutic interventions
during the entire patient encounter.
The Accreditation Council for Graduate Medical Education (ACGME) is implementing the
ACGME Outcome Project to assure that physicians are appropriately trained in the knowledge
and skills of their specialties. The ACGME derived 6 general (core) competencies thought to be
essential for any practicing physician: patient care, medical knowledge, practice-based learning
and improvement, interpersonal skills, professionalism, and systems-based practice.1 The 6
general competencies are an integral part of the practice of Emergency Medicine and are
embedded into the EM Model. To incorporate these competencies into the specialty of
Emergency Medicine, an Emergency Medicine Competency Task Force demonstrated how
these competencies are integrated into the EM Model in Chapman, et al.2
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The EM Model is designed for use as the core document for the specialty. It will provide the
foundation for developing future medical school and residency curricula, certification
examination specifications, continuing education objectives, research agendas, residency
program review requirements, and other documents necessary for the functional operation of
the specialty. In conjunction with the EM Model, these 6 general competencies construct a
framework for evaluation of physician performance and curriculum design to further refine and
improve the education and training of competent emergency physicians.
1
Accreditation Council for Graduate Medical Education (ACGME). ACGME Core Competencies.
(ACGME Outcome Project Website). Available at http://www.acgme.org/outcome/comp/compCPRL.asp
2
Chapman DM, Hayden S, Sanders AB, et al. Integrating the Accreditation Council for Graduate Medical
Education core competencies into The Model of the Clinical Practice of Emergency Medicine. Ann Emerg
Med. 2004;43:756-769, and Acad Emerg Med. 2004;11:674-685.
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Figure 1
Summary of 2009 EM Model Review Task Force
Recommendation and Changes within the 2007 EM Model
Proposed deletions are lined out. Proposed changes and additions appear in bold italics with yellow shading.
Overview – Patient Acuity
• Add language to the first sentence so it reads: “An emergency physician’s frame of
reference in a patient encounter is fundamentally related to the actual, apparent, or
potential acuity of the patient’s condition.”
Listing of Conditions and Components
• Add one more level of outline numbering detail to the listings between 1.0 and 18.3
• 1.3 Change spelling from “hiccough” to “hiccup”
• 7.2 Reposition Keratitis – Emergent and Lower Acuity under External Eye
• 10.2 Change “Biologic Weapons” to Biologic Weapons and Pandemics
• 10.7 Change “Emerging Infections” to Emerging Infections and Drug Resistance
• 13.1 Add Hyperstimulation – Critical, Emergent and Lower Acuity under Ovary
Appendix 1 – Procedures and Skills Integral to the Practice of Emergency Medicine
• Delete “Peritoneal lavage” from Diagnostic Procedures

• Change “Universal Precautions” to Exposure Management
• Add Personal Protection (equipment and techniques) under Exposure Management
• Change “Biohazard Decontamination” to Decontamination
2 – Other Components and Core Competencies of the Practice of Emergency Medicine

Performance Improvement PRACTICE-BASED LEARNING AND IMPROVEMENT
Evidenced-based Medicine and Interpretation of Medical Literature
Patient Safety and Error Reduction
Performance Improvement and Lifelong Learning
Practice Guidelines
Customer Patient Satisfaction and Service
COMMUNICATION AND INTERPERSONAL ISSUES INTERPERSONAL AND

COMMUNICATION SKILLS
Complaint Management
Conflict Resolution
Effective Patient and Family Communications
Interdepartmental and Medical Staff Relations
Media Interaction
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Patient and Provider Education

Team Building
Teaching
Communicating bad news
Professionalism PROFESSIONALISM
Advocacy
Conflicts of interest management
Ethics
Impairment
Leadership (Leading, Directing, and Mentoring)
Mentorship
Personal Well-being
Professional Development and Lifelong Learning
ADMINISTRATION SYSTEM-BASED PRACTICE
Contract Principles
Analysis of Clauses and Components
Employment v. Independent Contractor
Negotiation
Practice Models
Financial Issues
Budget and Planning
Cost Containment Effective Care and Resource Utilization
Managed Care
Reimbursement Issues, Billing, and Coding
Health Care Coordination

End-of-Life
Palliative Care
Operations
Department Administration
Documentation
Emergency Preparedness and Disease Management
Facility Design
Human Resource Management
Information Management
Patient Throughput and Crowding
Policies and Procedures
Safety and Security
Pre-hospital Care
Administration, Management, and Operations
Credentialing of Providers
Direct Patient Care
Direct Medical Command
Multi-casualty Incidents
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Performance Improvement
Protocol Development
Risk Management, Legal, And Regulatory Issues

Accreditation
Compliance
Confidentiality
Consent and Refusal of Care
Emergency Medical Treatment and Active Labor Act (EMTALA)
Liability and Malpractice Medical Liability
Reporting (Assault, Communicable Diseases, National Practitioner Data Bank, etc.)
Reporting Requirements
Risk Management
Systems-based Management
Managed Care
Emergency Preparedness and Disaster Management
End-of-Life Issues
RESEARCH
Evidence-based Medicine
Interpretation of Medical Literature
Performance of Research
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OVERVIEW
There are multiple components of “The Model of the Clinical Practice of Emergency Medicine.”
The components of the EM Model are given in two complementary documents: 1) the Matrix;
and 2) the Listing of Conditions and Components.
The EM Model is a three-dimensional description of Emergency Medicine (EM) clinical practice.

The three dimensions are patient acuity, physician tasks, and the listing of conditions and
components. All of these dimensions are interrelated and employed concurrently by a physician
when providing patient care. The EM physician’s initial approach is determined by the acuity of
the patient’s presentation. While assessing the patient, the physician completes a series of
tasks collecting information. Through this process, the physician is able to select the most likely
etiology of the patient’s problem from the listing of the conditions and components. Through
continued application of all three components, the physician is able to arrive at the most
probable diagnosis and subsequently implement a treatment plan for the patient. Hence, the
three dimensions of the EM Model are interrelated and applied concurrently in the practice of
Emergency Medicine.
Physician Tasks
The physician tasks include the range of activities and the dynamic nature of the practice of
Emergency Medicine (Table 1). Emergency physicians simultaneously consider multiple factors
involved in patient care that may alter the direction of patient management. For example, the
approach to the patient can change dramatically when considering a pediatric v. a geriatric
presentation of the same complaint, i.e., modifying factors. The physician tasks apply to
patients of all ages. Although there are no separate sections on the care of pediatric or geriatric
patients, users of the document should consider including pediatric and geriatric aspects of
patient care related to each task. When considered together, these tasks are directly related to
the six broad competencies expected of board certified emergency physicians.
Patient Acuity
An emergency physician’s frame of reference in a patient encounter is fundamentally related to
the actual, apparent, or potential acuity of the patient’s condition. Establishing the acuity level
is essential for defining the context for action, the priorities of the patient encounter, and
consequently, the order of tasks necessary to manage the patient successfully. In the EM
Model, patient acuity includes critical, emergent, and lower acuity (Table 2).
Matrix of Physician Tasks by Patient Acuity

The Matrix is organized along two principal dimensions: Patient Acuity and Physician Tasks
(Table 3). The Matrix represents all possible physician-patient interactions that are determined
by patient acuity and the tasks that may be performed during a patient encounter. Patient acuity
is most fundamental in determining the priority and sequence of tasks necessary to successfully
manage the presenting patient. The Matrix represents how an emergency physician modifies
the tasks necessary to perform appropriate patient care based on the patient acuity.
Following is a concise example of how patient acuity and physician tasks can be applied to
patients presenting with the same complaint of chest pain:
1. A 55-year old hypertensive diabetic male with crushing chest pain, diaphoresis, and a blood
pressure of 60 systolic who is clutching his chest.
Acuity Frame: Critical
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Implications: Immediate intervention is necessary to manage and stabilize vital functions.

High probability of mortality exists without immediate intervention.
2. A 74-year old female with a history of angina presenting with three-to-five minutes of dull
chest pain typical of her angina. She has stable vital signs and her pain is relieved by
nitroglycerin.
Acuity Frame: Emergent
Implications: Initiation of monitoring, vascular access, evaluation, and treatment must be
performed quickly. Progression in severity, complications, or morbidity may
occur without immediate treatment.
3. A 12-year old female with non-traumatic sharp chest pain lasting for several days that
intensifies with movement of the torso.
Acuity Frame: Lower acuity
Implications: Patient’s symptoms should be addressed promptly. However, progression to
major complications would be unlikely.
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Table 1.
Physician task definitions
Pre-hospital care Participate actively in pre-hospital care; provide direct patient care or on-line or off-line
medical direction or interact with pre-hospital medical providers; assimilate information
from pre-hospital care into the assessment and management of the patient.
Emergency stabilization Conduct primary assessment and take appropriate steps to stabilize and treat patients.
Performance of focused Communicate effectively to interpret and evaluate the patient’s symptoms and history;
history and physical identify pertinent risk factors in the patient’s history; provide a focused evaluation;
examination interpret the patient’s appearance, vital signs and condition; recognize pertinent
physical findings; perform techniques required for conducting the exam.
Modifying factors Recognize age, gender, ethnicity, barriers to communication, socioeconomic status,
underlying disease, and other factors that may affect patient management.
Professional and legal Understand and apply principles of professionalism, ethics, and legal concepts
issues pertinent to patient management.
Diagnostic studies Select and perform the most appropriate diagnostic studies and interpret the results,
e.g., electrocardiogram, emergency ultrasound, radiographic and laboratory tests.
Diagnosis Develop a differential diagnosis and establish the most likely diagnoses in light of the
history, physical, interventions, and test results.
Therapeutic Perform procedures and nonpharmacologic therapies, and counsel.

interventions
Pharmacotherapy Select appropriate pharmacotherapy, recognize pharmacokinetic properties, and

anticipate drug interactions and adverse effects.
Observation and Evaluate and re-evaluate the effectiveness of a patient’s treatment or therapy, including
reassessment addressing complications and potential errors; monitor, observe, manage, and maintain
the stability of one or more patients who are at different stages in their work-ups.
Consultation and Collaborate with physicians and other professionals to evaluate and treat patients,
disposition arrange appropriate placement and transfer if necessary, formulate a follow-up plan,
and communicate effectively with patients, family, and involved health care members.
Prevention and Apply epidemiologic information to patients at risk; conduct patient education; select
education appropriate disease and injury prevention techniques.
Documentation Communicate patient care information in a concise manner that facilitates quality care
and coding.
Multi-tasking and team Prioritize multiple patients in the emergency department in order to provide optimal
management patient care; interact, coordinate, educate, and supervise all members of the patient
management team; utilize appropriate hospital resources; have familiarity with disaster
management.
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Table 2.
Patient acuity definitions
Critical Emergent Lower Acuity
Patient presents with signs or Patient presents with signs or Patient presents with signs or
symptoms of a life-threatening symptoms of an illness or symptoms of an illness or
illness or injury with a high injury that may progress in injury that have a low
probability of mortality if severity or result in probability of rapid progression
immediate intervention is not complications with a high to more serious disease or
begun to prevent further probability for morbidity if development of complications.
airway, respiratory, treatment is not begun quickly.
hemodynamic, and/or
neurologic instability.
Table 3.
Matrix of physician tasks by patient acuity
Patient Acuity
Physician Tasks Critical Emergent Lower Acuity
Pre-hospital care
Emergency stabilization
Performance of focused
history and physical
examination
Modifying factors
Professional issues
Diagnostic studies
Diagnosis
Therapeutic interventions
Pharmacotherapy
Observation and reassessment
Consultation and disposition
Prevention and education
Documentation
Multi-tasking & team
management
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LISTING OF CONDITIONS AND COMPONENTS
The Listing of Conditions and Components contains the fundamental, or core, patient conditions
that present to emergency departments. The listing is based on data collected by the National
Center for Health Statistics at the Centers for Disease Control and Prevention (CDC) during
1995-1996. The CDC data were collected from 40,000 emergency department records
statistically representative of 90.3 million emergency department visits in metropolitan and non-
metropolitan short-stay or general hospitals in all 50 states and the District of Columbia.
Frequency of occurrence was a primary factor in determining inclusion in the Listing of
Conditions and Components. Frequency of occurrence, however, was not the sole determinant
of inclusion, nor was the number of entries pertaining to a single topic representative of
importance. The final list was developed by several expert panels of practicing emergency
physicians based on three factors: 1) frequency of occurrence; 2) critical nature of patient
presentation; and 3) other components of EM practice.
Appendix 1 outlines the diagnostic and/or therapeutic procedures or tests that are essential to
the clinical practice of Emergency Medicine. Emergency physicians must know the indications
for ordering, be able to perform, and be able to interpret the results of the listed items.
Appendix 2 lists the other essential components and core competencies of Emergency
Medicine practice. These include such items as practice-based learning and improvement
administration; interpersonal and communication skills and interpersonal issues;
professionalism research; and system-based practice; risk management, legal, and regulatory
issues research. Emergency physicians should have a basic knowledge of these components
and be able to apply them to their clinical practice.
NOTE: The Listing of Conditions and Components is not intended to be comprehensive. It is

intended to be representative of the most frequent conditions seen and those with the most
serious implications for patients presenting to the emergency department.
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Listing of Conditions and Components

1.0 SIGNS, SYMPTOMS, AND PRESENTATIONS
1.1 General
Altered mental status X X
Anxiety X
Apnea X
Ataxia X X
Back pain X X X
Bleeding X X X
Coma X
Confusion X
Crying/Fussiness X X
Cyanosis X
Decreased level of consciousness X X
Dehydration X X
Dizziness X X
Edema X X
Failure to thrive X X
Fatigue X X
Feeding problems X
Fever X X X
Hypotension X X
Jaundice X
Joint pain/Swelling X X
Limp X X
Lymphadenopathy X
Malaise X X
Multiple trauma X X
Needle stick X X
Pain X X X
Paralysis X X
Paresthesia/Dysesthesia X X
Poisoning X X X
Pruritus X X
Rash X X X
Shock X
SIDS (See 3.1) X
Sleeping problems X
Syncope X X X
Tremor X X
Weakness X X
Weight loss X X
1.2 Abdominal
Abnormal vaginal bleeding X X X
Anuria X
Ascites X X
Colic X X
Constipation X
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Cramps X X
Diarrhea X X
Dysmenorrhea X
Dysuria X
Hematemesis X X
Hematochezia X X X
Hematuria X X
Nausea/Vomiting X X
Pain X X X
Pelvic pain X X X
Peritonitis X X
Rectal bleeding X X X
Rectal pain X X
Urinary incontinence X
Urinary retention X
1.3 Chest
Chest pain X X X
Cough X X
Dyspnea X X
Hemoptysis X X
Hiccough Hiccup X
Palpitations X X X
Shortness of breath X X
Tachycardia X X
Wheezing X X
1.4 Head and Neck

Congestion X
Diplopia X
Dysphagia X X
Eye pain X X
Headache (See 12.3) X X X
Loss of hearing X
Loss of vision X
Rhinorrhea X
Sore throat X X
Stridor X X
Tinnitus X
Vertigo X X
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2.0 ABDOMINAL AND GASTROINTESTINAL DISORDERS
2.1 Abdominal Wall

Hernias X X
2.2 Esophagus
Infectious disorders
Candida (See 4.4, 7.5) X X
Inflammatory disorders
Esophagitis X X
Gastroesophageal reflux (GERD) X
Toxic effects of caustic (See 17.1)
Acid X X
Alkali X X
Motor abnormalities
Spasms X
Structural disorders
Boerhaave’s syndrome X X
Diverticula X X
Foreign body X
Hernias X X
Mallory-Weiss syndrome X X
Stricture and stenosis X X
Tracheoesophageal fistula X X
Varices X X
Tumors X X
2.3 Liver
Cirrhosis X X
Alcoholic X X
Biliary obstructive X
Drug-induced X X
Hepato-renal failure X X
Infectious disorders X X
Abscess X
Hepatitis
Acute X X
Chronic X
Tumors X X
2.4 Gall Bladder and Biliary Tract

Cholangitis X X
Cholecystitis X
Cholelithiasis/Choledocholithiasis X X
Tumors X X
2.5 Pancreas
Pancreatitis X X
Tumors X X
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2.6 Peritoneum
Spontaneous bacterial peritonitis X X
2.7 Stomach
Infectious disorders X
Gastritis X X
Peptic ulcer disease X X
Hemorrhage X X
Perforation X X
Congenital hypertrophic pyloric
stenosis X
Foreign body X X
Tumors X X
2.8 Small Bowel

Infectious disorders X X
Regional enteritis/Crohn’s disease X X
Motor abnormalities
Obstruction X
Paralytic ileus X
Aortoenteric fistula X
Congenital anomalies X X
Intestinal malabsorption X X
Meckel's diverticulum X X
Tumors X X
Vascular insufficiency X X
2.9 Large Bowel

Antibiotic associated X
Bacterial X X
Parasitic X X
Viral X X
Acute appendicitis X
Necrotizing enterocolitis (NEC) X X
Radiation colitis X
Ulcerative colitis X X
Motor abnormalities
Hirschsprung’s disease X X
Irritable bowel X
Obstruction X
Congenital anomalies X X
Diverticula X X
Intussusception X X
Volvulus X X
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Tumors X X
2.10 Rectum and Anus

Perianal/Anal abscess X X
Perirectal abscess X
Pilonidal cyst and abscess X X
Proctitis X
Anal fissure X
Anal fistula X X
Congenital anomalies X
Foreign body X X
Hemorrhoids X
Rectal prolapse X
Tumors X X
2.11 Spleen X X X
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3.0 CARDIOVASCULAR DISORDERS
3.1 Cardiopulmonary Arrest X

SIDS (See 1.1) X
3.2 Congenital Abnormalities of the Cardiovascular System

Disorders due to anatomic anomalies X X X
Genetically transmitted disorders X X X
3.3 Disorders of Circulation

Arterial
Aneurysm X X X
Aortic dissection X
Thromboembolism X X
Venous
Thromboembolism (See 16.6) X X
3.4 Disturbances of Cardiac Rhythm

Cardiac dysrhythmias X X X
Ventricular X X
Supraventricular X X X
Conduction disorders X X X
3.5 Diseases of the Myocardium, Acquired

Cardiac failure X X
Cor pulmonale X X
High output X X
Low output X X
Cardiomyopathy X X X
Hypertrophic X X X
Congestive heart failure X X
Coronary syndromes X X
Ischemic heart disease X X
Myocardial infarction X X
Myocarditis X X X
Ventricular aneurysm X X X
3.6 Diseases of the Pericardium

Pericardial tamponade (See 18.1) X X
Pericarditis X X
3.7 Endocarditis X X
3.8 Hypertension X X X
3.9 Tumors X X
3.10 Valvular Disorders X X X

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4.0 CUTANEOUS DISORDERS
4.1 Cancers of the Skin

Basal cell X
Kaposi's sarcoma X
Melanoma X
Squamous cell X
4.2 Decubitus Ulcer X X
4.3 Dermatitis
Atopic X
Contact X
Eczema X
Psoriasis X
Sebaceous cyst X
Seborrhea X
4.4 Infections
Bacterial
Abscess X X
Cellulitis X X
Erysipelas X
Impetigo X
Necrotizing infection X X
Fungal
Candida (See 2.2, 7.5) X
Tinea X
Parasitic
Pediculosis infestation X
Scabies X
Viral
Aphthous ulcers X
Erythema infectiosum X
Herpes simplex (See 10.6, 13.1) X
Herpes zoster (See 10.6) X X
Human papillomavirus (HPV) (See 13.1) X
Molluscum contagiosum X
Warts X
4.5 Maculopapular Lesions

Erythema multiforme X X
Erythema nodosum X
Henoch-Schönlein purpura (HSP) X
Pityriasis rosea X
Purpura X X
Urticaria X X
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4.6 Papular/Nodular Lesions
Hemangioma/Lymphangioma X
Lipoma X
4.7 Vesicular/Bullous Lesions

Pemphigus X
Staphylococcal scalded skin syndrome X X
Stevens-Johnson syndrome X X
Toxic epidermal necrolysis X X
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5.0 ENDOCRINE, METABOLIC, AND NUTRITIONAL DISORDERS
5.1 Acid-base Disturbances

Metabolic or respiratory
Acidosis X X
Alkalosis X X X
Mixed acid-base balance disorder X X
5.2 Adrenal Disease

Corticoadrenal insufficiency X X
Cushing’s syndrome X X
5.3 Fluid and Electrolyte Disturbances

Calcium metabolism X X X
Fluid overload/Volume depletion X X
Hyperkalemia/Hypokalemia X X X
Hypernatremia/Hyponatremia X X X
Magnesium metabolism X X
Phosphorus metabolism X X
5.4 Glucose Metabolism

Diabetes mellitus
Type I X X X
Type II X X
Complications in glucose metabolism
Diabetic ketoacidosis (DKA) X X
Hyperglycemia X X
Hyperosmolar coma X X
Hypoglycemia X X
Systemic X X
5.5 Nutritional Disorders

Vitamin deficiencies X
Vitamin excess X
Wernicke-Korsakoff syndrome X
5.6 Parathyroid Disease X X
5.7 Pituitary Disorders X X

Panhypopituitarism X
5.8 Thyroid Disorders

Hyperthyroidism X X X
Hypothyroidism X X X
Thyroiditis X X
5.9 Tumors of Endocrine Glands

Adrenal X X
Pituitary X X
Thyroid X X
Page 22

6.0 ENVIRONMENTAL DISORDERS
6.1 Bites and Envenomation (See 18.1)

Arthropods X X
Insects X
Spiders X X
Mammals X X
Marine organisms (See 17.1) X X X
Snakes X X X
6.2 Dysbarism
Air embolism X X
Barotrauma X X X
Decompression syndrome X X
6.3 Electrical Injury (See 18.1) X X X

Lightning X X
6.4 High-altitude Illness

Acute mountain sickness X X
Barotrauma of ascent X X
High-altitude cerebral edema X X
High-altitude pulmonary edema X X
6.5 Submersion Incidents

Cold water immersion X X
Near drowning X X
6.6 Temperature-related Illness

Heat
Heat exhaustion X X
Heat stroke X
Cold
Frostbite X X
Hypothermia X X
6.7 Radiation Emergencies X X X

Page 23

7.0 HEAD, EAR, EYE, NOSE, THROAT DISORDERS
7.1 Ear
Foreign body X X
Impacted cerumen X
Labyrinthitis X
Mastoiditis X
Meniere's disease X
Otitis externa X
Infective X
Malignant X
Otitis media X X
Perforated tympanic membrane (See 18.1) X
7.2 Eye
External eye
Blepharitis X
Burn confined to eye and adnexa (See 18.1) X
Conjunctivitis X
Corneal abrasions (See 18.1) X X
Dacryocystitis X X
Disorders of lacrimal system X
Foreign body X X
Inflammation of the eyelids X
Chalazion X
Hordeolum X
Keratitis X X
Anterior pole
Glaucoma X X
Hyphema (See 18.1) X X
Iritis (See 18.1) X X
Posterior pole
Choroiditis/Chorioretinitis X
Optic neuritis X
Papilledema X X
Retinal detachments and defects (See 18.1) X
Retinal vascular occlusion X
Orbit
Cellulitis
Preseptal X
Postseptal X
Purulent endophthalmitis X
7.3 Cavernous Sinus Thrombosis X X
7.4 Nose
Epistaxis X X X
Foreign body X X
Rhinitis X
Sinusitis X
Page 24
7.5 Oropharynx/Throat
Dentalgia X
Diseases of the oral soft tissue
Ludwig's angina X X
Stomatitis X
Diseases of the salivary glands
Sialolithiasis X X
Suppurative parotitis X
Foreign body X X
Gingival and periodontal disorders
Gingivostomatitis X
Larynx/Trachea
Epiglottitis (See 16.1) X X
Laryngitis X
Tracheitis X X
Oral candidiasis (See 2.2, 4.4) X
Periapical abscess X X
Peritonsillar abscess X
Pharyngitis/Tonsillitis X
Retropharyngeal abscess X X
Temporomandibular joint disorders X
7.6 Tumors X X
Page 25

8.0 HEMATOLOGIC DISORDERS
8.1 Blood Transfusion

Complications X X
8.2 Hemostatic Disorders

Coagulation defects X X X
Acquired X X X
Hemophilias X X X
Disseminated intravascular coagulation X
Platelet disorders X X X
Thrombocytopenia X X
8.3 Lymphomas X X
8.4 Pancytopenia X X
8.5 Red Blood Cell Disorders

Anemias
Aplastic X X
Hemoglobinopathies X X
Sickle cell disease X X
Hemolytic X
Hypochromic
Iron deficiency X X
Megaloblastic X X
Polycythemia X X
Methemoglobinemia (See 17.1) X X
8.6 White Blood Cell Disorders

Leukemia X X
Multiple myeloma X X
Leukopenia X X
Page 26

9.0 IMMUNE SYSTEM DISORDERS
9.1 Collagen Vascular Disease

Raynaud’s disease X
Reiter’s syndrome X X
Rheumatoid arthritis (See 11.3) X X
Scleroderma X X
Systemic lupus erythematosus X X
Vasculitis X X
9.2 HIV and Manifestations (See 10.6) X X X
9.3 Hypersensitivity
Allergic reaction X X
Anaphylaxis X
Angioedema X X
Drug allergies X X X
9.4 Kawasaki Syndrome X
9.5 Sarcoidosis X X
9.6 Transplant-related Problems X X X

Immunosuppression X X
Rejection X X
9.7 Rheumatic Fever X X

Page 27

10.0 SYSTEMIC INFECTIOUS DISORDERS
10.1 Bacterial
Bacterial food poisoning X X
Botulism X X
Chlamydia X X
Gonococcal infections X X
Meningococcemia X X
Mycobacterial infections
Atypical mycobacteria X X
Tuberculosis X X
Other bacterial diseases X X
Gas gangrene (See 11.6) X X
Sepsis/Bacteremia X X
Shock X
Systemic inflammatory response
syndrome (SIRS) X X
Toxic shock syndrome X X
Spirochetes
Syphilis X X
Tetanus X X
10.2 Biologic Weapons and Pandemics X X
10.3 Fungal Infections X X
10.4 Protozoan/Parasites
Malaria X
Toxoplasmosis X X
10.5 Tick-borne
Ehrlichiosis X
Lyme disease X
Rocky Mountain spotted fever X
10.6 Viral X X
Infectious mononucleosis X X
Influenza/Parainfluenza X X
Hantavirus X X
Herpes simplex (See 4.4, 13.1) X X
Herpes zoster/Varicella (See 4.4) X X
HIV (See 9.2) X X X
Rabies X
Roseola X
Rubella X
10.7 Emerging Infections/Pandemics and Drug X X

Resistance
Page 28

11.0 MUSCULOSKELETAL DISORDERS (NONTRAUMATIC)
11.1 Bony Abnormalities

Aseptic necrosis of hip X X
Osteomyelitis X
Tumors X X
11.2 Disorders of the Spine

Disc disorders X X
Inflammatory spondylopathies X X
Low back pain
Cauda equina syndrome (See 18.1) X X
Sacroiliitis X
Sprains/Strains X
11.3 Joint Abnormalities

Arthritis
Septic X
Gout X X
Rheumatoid (See 9.1) X
Juvenile X
Osteoarthrosis X
Congenital dislocation of the hip X X
Slipped capital femoral epiphysis X
11.4 Muscle Abnormalities

Myalgia/Myositis X
Rhabdomyolysis X X
11.5 Overuse Syndromes

Bursitis X
Muscle strains X
Peripheral nerve syndrome X
Carpal tunnel syndrome X
Tendonitis X
11.6 Soft Tissue Infections

Fasciitis X
Felon X
Gangrene (See 10.1) X X
Paronychia X X
Synovitis/Tenosynovitis X X
Page 29

12.0 NERVOUS SYSTEM DISORDERS
12.1 Cranial Nerve Disorders X

Idiopathic facial nerve paralysis (Bell’s palsy) X
Trigeminal neuralgia X
12.2 Demyelinating Disorders X X

Multiple sclerosis X X
12.3 Headache (See 1.4) X X X

Muscle contraction X
Vascular X X
12.4 Hydrocephalus X X
Normal pressure X X
VP shunt X
12.5 Infections/Inflammatory Disorders

Encephalitis X X
Intracranial and intraspinal abscess X X
Meningitis
Bacterial X X
Viral X X
Myelitis X
Neuralgia/Neuritis X
12.6 Movement Disorders X X

Dystonic reaction X X
12.7 Neuromuscular Disorders

Guillain-Barré syndrome X X
Myasthenia gravis X X X
Peripheral neuropathy X
12.8 Other Conditions of the Brain

Dementia (See 14.5) X
Parkinson’s disease X
Pseudotumor cerebri X X
12.9 Seizure Disorders X X X

Febrile X X
Neonatal X
Status epilepticus X
12.10 Spinal Cord Compression X X
12.11 Stroke
Hemorrhagic
Intracerebral X X
Subarachnoid X X
Page 30

Ischemic
Embolic X X
Thrombotic X X
12.12 Transient Cerebral Ischemia X X
12.13 Tumors X X
Page 31

13.0 OBSTETRICS AND GYNECOLOGY
13.1 Female Genital Tract

Cervix
Cervicitis and endocervicitis X X
Tumors X
Pelvic inflammatory disease X
Fitz-Hugh-Curtis syndrome X
Tubo-ovarian abscess X
Lesions
Herpes simplex (See 4.4, 10.6) X
Human papillomavirus (HPV) (See 4.4) X
Ovary
Cyst X
Hyperstimulation X X X
Torsion X
Tumors X X
Uterus
Dysfunctional bleeding X X
Endometriosis X
Prolapse X
Tumors X X
Gestational trophoblastic disease X
Leiomyoma X
Vagina and vulva
Bartholin’s abscess X
Foreign body X X
Vaginitis/Vulvovaginitis X
13.2 Normal Pregnancy X
13.3 Complications of Pregnancy

Abortion X
Ectopic pregnancy X X
Hemolysis, elevated liver enzymes,
low platelets (HELLP) syndrome X X
Hemorrhage, antepartum
Abruptio placentae (See 18.2) X X
Placenta previa X X
Hyperemesis gravidarum X X
Hypertension complicating pregnancy X X
Eclampsia X X
Preeclampsia X
Infections X
Rh isoimmunization X
13.4 High-risk Pregnancy X X
13.5 Normal Labor and Delivery X X

Page 32
13.6 Complications of Labor

Fetal distress X
Premature labor (See 18.2) X
Premature rupture of membranes X
Rupture of uterus (See 18.2) X
13.7 Complications of Delivery

Malposition of fetus X X
Nuchal cord X
Prolapse of cord X
13.8 Postpartum Complications

Endometritis X
Hemorrhage X X
Mastitis X X
Page 33

14.0 PSYCHOBEHAVIORAL DISORDERS
14.1 Addictive Behavior

Alcohol dependence X
Drug dependence X
Eating disorders X X
Substance abuse X
14.2 Mood Disorders and Thought Disorders

Acute Psychosis X X
Bipolar disorder X X
Depression X X
Suicidal risk X X
Grief reaction X
Schizophrenia X X
14.3 Factitious Disorders

Drug-seeking behavior X
Munchausen syndrome/Munchausen by proxy X X
14.4 Neurotic Disorders

Anxiety/Panic X
Obsessive compulsive X
Phobic X
Post-traumatic stress X
14.5 Organic Psychoses

Chronic organic psychotic conditions X
Alcoholic psychoses X X
Drug psychoses X X
Delirium X
Dementia (See 12.8) X
Intoxication and/or withdrawal (See 17.1)
Alcohol X X X
Hallucinogens X X
Opioids X X X
Phencyclidine X
Sedatives/Hypnotics/Anxiolytics X X X
Sympathomimetics and cocaine X X X
14.6 Patterns of Violence/Abuse/Neglect

Interpersonal violence
Child, intimate partner, elder X
Homicidal Risk X X
Sexual assault X
Staff/Patient safety X
14.7 Personality Disorders X

Page 34

14.8 Psychosomatic Disorders
Hypochondriasis X
Hysteria/Conversion X
Page 35

15.0 RENAL AND UROGENITAL DISORDERS
15.1 Acute and Chronic Renal Failure X X X
15.2 Complications of Renal Dialysis X X
15.3 Glomerular Disorders

Glomerulonephritis X X
Nephrotic syndrome X X
15.4 Infection
Cystitis X
Pyelonephritis X
Urinary tract infection (UTI) X
15.5 Male Genital Tract

Genital lesions X
Hernias X X
Inflammation/Infection
Balanitis/Balanoposthitis X X
Epididymitis/Orchitis X X
Gangrene of the scrotum
(Fournier's gangrene) X X
Prostatitis X X
Urethritis X
Structural
Paraphimosis/Phimosis X
Priapism X
Prostatic hypertrophy (BPH) X
Torsion of testis X
Testicular masses X
Tumors
Prostate X
Testis X
15.6 Nephritis X X
Hemolytic uremic syndrome X
15.7 Structural Disorders

Calculus of urinary tract X X
Obstructive uropathy X
Polycystic kidney disease X
15.8 Tumors X
Page 36

16.0 THORACIC-RESPIRATORY DISORDERS
16.1 Acute Upper Airway Disorders

Infections
Croup X
Epiglottitis (See 7.5) X X
Pertussis/Whooping cough X X
Upper respiratory infection X
Obstruction X
Tracheostomy/Complications X X
16.2 Disorders of Pleura, Mediastinum, and Chest Wall

Costochondritis X
Mediastinitis X X
Pleural effusion X X
Pleuritis X
Pneumomediastinum X
Pneumothorax (See 18.1)
Simple X
Tension X
16.3 Noncardiogenic Pulmonary Edema X X
16.4 Obstructive/Restrictive Lung Disease

Asthma/Reactive airway disease X X
Bronchitis and bronchiolitis X X
Bronchopulmonary dysplasia X X
Chronic obstructive pulmonary disease X X X
Cystic fibrosis X X X
Environmental/Industrial exposure X X X
Foreign body X X
16.5 Physical and Chemical Irritants/Insults

Pneumoconiosis X X
Toxic effects of gases, fumes, vapors
(See 18.1) X X X
16.6 Pulmonary Embolism/Infarct

Septic emboli X X
Venous thromboembolism (See 3.3) X X
16.7 Pulmonary Infections

Lung abscess X
Pneumonia
Aspiration X X
Atypical X
Bacterial X X
Chlamydia X
Fungal X X
Mycoplasmal X X
Page 37

Viral X X X
Pulmonary tuberculosis X
16.8 Tumors
Breast X
Chest wall X
Pulmonary X X
Page 38

17.0 TOXICOLOGIC DISORDERS
17.1 Drug and Chemical Classes

Analgesics
Acetaminophen X
Nonsteroidal anti-inflammatories
(NSAIDS) X X
Opiates and related narcotics X X
Salicylates X X
Alcohol
Ethanol X X X
Glycol X X
Isopropyl X X X
Methanol X X
Anesthetics X X
Anticholinergics/Cholinergics X X
Anticoagulants X X
Anticonvulsants X X
Antidepressants X X
Antiparkinsonism drugs X
Antihistamines and antiemetics X
Antipsychotics X X
Bronchodilators X
Carbon monoxide X X
Cardiovascular drugs
Antiarrhythmics X X
Digitalis X X
Antihypertensives X X
Beta blockers X X
Calcium channel blockers X X
Caustic agents
Acid X X
Alkali X X
Cocaine X X X
Cyanides, hydrogen sulfide X X
Hallucinogens X X
Hazardous materials X X
Heavy metals X X
Herbicides, insecticides, and rodenticides X X
Household/Industrial chemicals X X X
Hormones/Steroids X X
Hydrocarbons X X
Hypoglycemics/Insulin X X
Inhaled toxins X X
Iron X X
Isoniazid X X
Marine toxins (See 6.1) X X X
Methemoglobinemia (See 8.5) X X
Mushrooms/Poisonous plants X X
Neuroleptics X X
Page 39

Non-prescription drugs X X
Organophosphates X X
Recreational drugs X X X
Sedatives/Hypnotics X X
Stimulants/Sympathomimetics X X
Strychnine X X
Lithium X X X
Page 40

18.0 TRAUMATIC DISORDERS
18.1 Trauma
Abdominal trauma
Diaphragm X X
Hollow viscus X X
Penetrating X X
Retroperitoneum X X
Solid organ X X
Vascular X X
Chest trauma
Aortic dissection/Disruption X
Contusion
Cardiac X X X
Pulmonary X X
Fracture
Clavicle X X
Ribs/Flail chest X X X
Sternum X X
Hemothorax X X
Penetrating chest trauma X X
Pericardial tamponade (See 3.6) X
Pneumothorax (See 16.2)
Simple X
Tension X
Cutaneous injuries
Avulsions X X
Bite wounds (See 6.1) X X
Burns
Electrical (See 6.3) X X X
Chemical (See 16.5) X X X
Thermal X X X
Lacerations X X
Puncture wounds X X
Facial fractures X
Dental X X
Le Fort X X X
Mandibular X X
Orbital X X
Genitourinary trauma
Bladder X
External genitalia X
Renal X X
Ureteral X
Head trauma
Intracranial injury X X
Scalp lacerations/Avulsions X X
Skull fractures X X
Injuries of the spine
Dislocations/Subluxations X X
Page 41

Fractures X X X
Sprains/Strains X
Lower extremity bony trauma
Dislocations/Subluxations X
Fractures (open and closed) X X
Neck trauma
Laryngotracheal injuries X X
Penetrating neck trauma X X
Vascular injuries
Carotid artery X X
Jugular vein X X
Ophthalmologic trauma
Corneal abrasions/Lacerations
(See 7.2) X X
Corneal burns
Acid X
Alkali X
Ultraviolet X X
Eyelid lacerations X
Foreign body X
Hyphema (See 7.2) X
Lacrimal duct injuries X
Penetrating globe injuries X
Retinal detachments (See 7.2) X
Traumatic iritis (See 7.2) X X
Retrobulbar Hematoma X
Otologic trauma
Hematoma X X
Perforated tympanic membrane (See 7.1) X
Pediatric fractures
Epiphyseal X X
Greenstick X
Torus X
Pelvic fracture X X
Soft-tissue extremity injuries
Amputations/Replantation X
Compartment syndromes X
High-pressure injection X
Injuries to joints X X
Knee X X
Penetrating X
Penetrating soft-tissue X X
Periarticular X
Sprains and strains X
Tendon injuries
Lacerations/Transections X
Ruptures X
Achilles tendon X
Patellar tendon X
Vascular injuries X X
Spinal cord and nervous system trauma
Page 42

Cauda equina syndrome (See 11.2) X X
Injury to nerve roots X X
Peripheral nerve injury X X
Spinal cord injury X X
Spinal cord injury without
radiologic abnormality (SCIWORA) X
Upper extremity bony trauma
Dislocations/Subluxations X
Fractures (open and closed) X X
18.2 Trauma in Pregnancy

Abruptio placentae (See 13.3) X X
Perimortem C-section X
Premature labor (See 13.6) X
Rupture of uterus (See 13.6) X
18.3 Multi-system Trauma X X

Blast injury X X
Page 43
APPENDIX 1.
Procedures and Skills Integral to the Practice of Emergency Medicine
Airway Techniques
Airway adjuncts Hemodynamic Techniques
Cricothyrotomy Arterial catheter insertion
Foreign body removal Central venous access
Intubation Intraosseous infusion
Mechanical ventilation Peripheral venous cutdown
Percutaneous transtracheal ventilation
Capnometry Obstetrics
Non-invasive ventilatory management Delivery of newborn
Anesthesia Other Techniques

Local Excision of thrombosed hemorrhoids
Regional nerve block Foreign body removal
Sedation - analgesia for procedures Gastric lavage
Gastrostomy tube replacement
Blood, Fluid, and Component Therapy Incision/Drainage
Administration Pain management (See Anesthesia)
Violent patient management/restraint
Diagnostic Procedures Sexual assault examination
Anoscopy Trephination, nails
Arthrocentesis Wound closure techniques
Bedside ultrasonography Wound management
Cystourethrogram Procedural ultrasonography
Lumbar puncture Escharotomy
Nasogastric tube
Paracentesis Resuscitation
Pericardiocentesis Cardiopulmonary resuscitation (CPR)
Peritoneal lavage Neonatal resuscitation
Slit lamp examination
Thoracentesis Skeletal Procedures
Tonometry Fracture/Dislocation immobilization techniques
Compartment pressure measurement Fracture/Dislocation reduction techniques
Spine immobilization techniques
Genital/Urinary
Bladder catheterization
1. Foley catheter Thoracic
2. Suprapubic Cardiac pacing
Testicular detorsion 1. Cutaneous
2. Transvenous
Head and Neck Defibrillation/Cardioversion
Control of epistaxis Thoracostomy
Laryngoscopy Thoracotomy
Drainage of peritonsillar abscess
Removal of rust ring Universal Precautions Exposure Management
Tooth stabilization Personal Protection (equipment and techniques)
Lateral canthotomy Biohazard Decontamination
Page 44
APPENDIX 2.
Other Components and Core Competencies of the Practice of Emergency Medicine
Performance Improvement PRACTICE-BASED LEARNING AND IMPROVEMENT

Evidenced-based Medicine and Interpretation of Medical Literature
Patient Safety and Error Reduction
Performance Improvement and Lifelong Learning
Practice Guidelines
Customer Patient Satisfaction and Service
COMMUNICATION AND INTERPERSONAL ISSUES INTERPERSONAL AND

COMMUNICATION SKILLS
Complaint Management
Conflict Resolution
Effective Patient and Family Communications
Interdepartmental and Medical Staff Relations
Media Interaction
Patient and Provider Education
Team Building
Teaching
Communicating bad news
Professionalism PROFESSIONALISM
Advocacy
Conflicts of interest management
Ethics
Impairment
Leadership (Leading, Directing, and Mentoring)
Mentorship
Personal Well-being
Professional Development and Lifelong Learning
ADMINISTRATION SYSTEM-BASED PRACTICE
Contract Principles
Analysis of Clauses and Components
Employment v. Independent Contractor
Negotiation
Practice Models
Financial Issues
Budget and Planning
Cost Containment Effective Care and Resource Utilization
Managed Care
Reimbursement Issues, Billing, and Coding
Page 45
Health Care Coordination

End-of-Life
Palliative Care
Operations
Department Administration
Documentation
Emergency Preparedness and Disease Management
Facility Design
Human Resource Management
Information Management
Patient Throughput and Crowding
Policies and Procedures
Safety and Security
Pre-hospital Care
Administration, Management, and Operations
Credentialing of Providers
Direct Patient Care
Direct Medical Command
Multi-casualty Incidents
Performance Improvement
Protocol Development
Risk Management, Legal, And Regulatory Issues

Accreditation
Compliance
Confidentiality
Consent and Refusal of Care
Emergency Medical Treatment and Active Labor Act (EMTALA)
Liability and Malpractice Medical Liability
Reporting (Assault, Communicable Diseases, National Practitioner Data Bank, etc.)
Reporting Requirements
Risk Management
Systems-based Management
Managed Care
Emergency Preparedness and Disaster Management
End-of-Life Issues
RESEARCH
Evidence-based Medicine
Interpretation of Medical Literature
Performance of Research
Page 46
The following individuals also made contributions to the 2001 EM Model:
Carey D. Chisholm, M.D. American College of Emergency Physicians

Steven C. Dronen, M.D. Rebecca Garcia, Ph.D.
Samuel M. Keim, M.D. Marjorie A. Geist, Ph.D., R.N.
Jo Ellen Linder, M.D.
John B. McCabe, M.D.
Marcus L. Martin, M.D. National Board of Medical Examiners (Consultants)
John C. Moorhead, M.D. Kristina G. Golden, M.A.
Ingrid Mudge, M.D. Anthony LaDuca, Ph.D.
Scott A. Syverud, M.D. Nancy A. Orr, Ph.D.
American Board of Emergency Medicine Residency Review Committee – Emergency Medicine

Susan K. Adsit Larry D. Sulton, Ph.D.
Hazen P. Ham, Ph.D. Linda M. Thorsen
Benson S. Munger, Ph.D.
Michael W. Radke, Ph.D.
Mary Ann Reinhart, Ph.D.
Dr. LaDuca made substantial intellectual contributions to the EM Model stemming from his many years of research
and thinking about the contextual framework of professionals in practice.
Core Content Task Force II thanks the seven emergency physicians who assisted the Task Force in pilot testing the
national survey used to validate this study. Their input to the process was extremely valuable. In addition, a very
special thanks to the 1,084 ABEM diplomates who participated in the national survey during a very busy time of the
year; their responses and comments were helpful in finalizing this document.
The following individuals also made contributions to the 2007 EM Model:

American Board of Emergency Medicine
Susan K. Adsit
Julie N. Keehbauch
Mary Ann Reinhart, Ph.D.
Colleen P. Robinson
Marlene J. Soderstrom
American College of Emergency Physicians
Marjorie A. Geist, Ph.D., R.N.
With special appreciation to Susan M. Dunsmore, Administrative Assistant, ABEM, for support in developing and
maintaining the EM Model.
/smd
2/2/2010
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2009 Model of the Clinical Practice of Emergency Medicine

Approved by the ACEP Board of Directors September 2003

2009 EM Model Review 2007 EM Model Review 2005 EM Model Review

2003 EM Model Review Core Content Advisory Panel to the

• American Board of Emergency Medicine (ABEM)

• Society for Academic Emergency Medicine (SAEM)

There are three components to the EM Model: 1) an assessment of patient acuity; 2) a

Overview – Patient Acuity

Listing of Conditions and Components

• 1.3 Change spelling from “hiccough” to “hiccup”

• 10.2 Change “Biologic Weapons” to Biologic Weapons and Pandemics

• 10.7 Change “Emerging Infections” to Emerging Infections and Drug Resistance

Appendix 1 – Procedures and Skills Integral to the Practice of Emergency Medicine

• Delete “Peritoneal lavage” from Diagnostic Procedures

2 – Other Components and Core Competencies of the Practice of Emergency Medicine

COMMUNICATION AND INTERPERSONAL ISSUES INTERPERSONAL AND

Patient and Provider Education

ADMINISTRATION SYSTEM-BASED PRACTICE

Health Care Coordination

Risk Management, Legal, And Regulatory Issues

The EM Model is a three-dimensional description of Emergency Medicine (EM) clinical practice.

Matrix of Physician Tasks by Patient Acuity

Implications: Immediate intervention is necessary to manage and stabilize vital functions.

Therapeutic Perform procedures and nonpharmacologic therapies, and counsel.

Pharmacotherapy Select appropriate pharmacotherapy, recognize pharmacokinetic properties, and

Critical Emergent Lower Acuity

Physician Tasks Critical Emergent Lower Acuity

LISTING OF CONDITIONS AND COMPONENTS

NOTE: The Listing of Conditions and Components is not intended to be comprehensive. It is

Listing of Conditions and Components

Critical Emergent Lower Acuity

Critical Emergent Lower Acuity

1.4 Head and Neck

Critical Emergent Lower Acuity

2.1 Abdominal Wall

2.4 Gall Bladder and Biliary Tract

Critical Emergent Lower Acuity

2.8 Small Bowel

2.9 Large Bowel

Critical Emergent Lower Acuity

2.10 Rectum and Anus

Critical Emergent Lower Acuity

3.1 Cardiopulmonary Arrest X

3.2 Congenital Abnormalities of the Cardiovascular System

3.3 Disorders of Circulation

3.4 Disturbances of Cardiac Rhythm

3.5 Diseases of the Myocardium, Acquired

3.6 Diseases of the Pericardium

3.10 Valvular Disorders X X X

Critical Emergent Lower Acuity

4.1 Cancers of the Skin

4.2 Decubitus Ulcer X X

4.5 Maculopapular Lesions

Critical Emergent Lower Acuity

4.7 Vesicular/Bullous Lesions

Critical Emergent Lower Acuity

5.1 Acid-base Disturbances

5.2 Adrenal Disease

5.3 Fluid and Electrolyte Disturbances

5.4 Glucose Metabolism

5.5 Nutritional Disorders

5.6 Parathyroid Disease X X